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Birth to Breast
Affording an IBCLC
Because of the Affordable Care Act, every insurance is required to cover lactation support. On this page, you will learn what free lactation support groups exist, what IBCLCs take what insurance, & insurance information on ways you can have your insurance cover a visit with an out-of-network IBCLC.
Insurance information
Common insurances and my experience (may not be accurate to you)
Tricare prime and select
Parents with Tricare Prime and select have the option for in-network providers and non-network providers. In-network providers bill Tricare directly for you and the only cost you may face is a travel fee for home visits. Non-network providers may charge higher so you may have some out-of-pocket cost in addition to a travel fee for a home visit. Non-network providers may or may not bill Tricare for you. If they require you to bill Tricare, you would pay the consult out of pocket, the provider would give you a superbill, and you would have the submit that superbill to Tricare for reimbursement. To find a provider you can search tricare's website. Tricare covers 6 lactation billing codes. This can be 6 one-hour consults or 2-3 90-minute-2-hour consults.
Aetna PPO
Patients with Aetna PPO may get between 3-6 covered consults (possibly more with out-of-pocket cost) with an in-network provider but this depends on their specific situation. It is always recommended to call your insurance to see if they have some specific information for you. Some Aetna plans may let you use an out-of-network provider but may have some requirements like meeting your deductible or preauthorization. Doing this often requires you to pay out of pocket and see if insurance will reimburse you. If you would want to have the provider bill for you see GAP insurance below. Travel fees for home visits are never covered by insurance. If your card has a PNOA or Multiplan logo you may be able to use The lactation network.
United Healthcare PPO
Patients with UHC may get between 3-6 covered consults (possibly more with out-of-pocket cost) with an in-network provider but this depends on their specific situation. It is always recommended to call your insurance to see if they have some specific information for you. Some UHC plans may let you use an out-of-network provider but may have some requirements like meeting your deductible or preauthorization. Doing this often requires you to pay out of pocket and see if insurance will reimburse you. If you would want to have the provider bill for you see GAP insurance below. Travel fees for home visits are never covered by insurance. If your card has a PNOA or Multiplan logo you may be able to use The lactation network.
Anthem blue cross PPO, Blue cross PPO, Blue shield PPO, ChampVA, Cigna PPO
The lactation network is a service that offers usually 6 covered visits for parents who qualify.
Options if your unable to use insurance
Superbill
This option may work for most PPO insurances and Tricare. For this option, the client pays the lactation consultant out-of-pocket and the lactation consultant then sends the superbill to their provider for reimbursement. On occasion, the health insurance may ask for a statement from the client stating why they weren't able to see anyone in-network and a letter of necessity from the baby's pediatrician. You would then follow the steps your insurance provider tells you to submit an out-of-network claim.
Gap coverage
Gap coverage is an option used mostly for PPO insurance. For this option you would call your health insurance ahead of time and request to see the out-of-network provider. The Out-of-network provider must be willing to bill your insurance directly. If your insurance does not pay out you will still be responsible for the consultation cost.
Flexible spending accounts
Using a flexible spending account or health spending account is typically an option for PPO insurance and can be a great one for families with United Healthcare. For this, you would pay for your consultation with your flexible spending account card. Requesting a superbill can be handy in case your insurance wants to know more information.
In-network provider
An in-network provider is a provider who has signed a contract with your insurance company. They agree to not charge any insurance-covered fees to the client unless the insurance company states they owe it on the EOB. An in-network provider will also submit your claim directly to insurance.
Flexible spending accounts
Using a flexible spending account or health spending account is typically an option for PPO insurance and can be a great one for families with United Healthcare. For this, you would pay for your consultation with your flexible spending account card. Requesting a superbill can be handy in case your insurance wants to know more information.
The lactation network
The lactation network is a company that contracts with Lactation consultants and bills your insurance. They guarantee a number of covered consults (not including travel fees) for families. Usually, PPO plans are accepter through them.
Support group
See more below.